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Dr. Bernard Rosenfeld, 73, has not been able to find a successor for his abortion practice in Houston, Texas. He says younger doctors don’t want to deal with the politics and protesters.

In Part 1 of this series, Houston Public Media looks at how the battle over reproductive rights has penetrated academic medicine in Texas, forcing abortion training ever deeper into the shadows.

Every year, more than 100 new obstetrician-gynecologists graduate from a residency program in Texas and enter the medical workforce. Theoretically, all of them have had the opportunity during the four years of residency to learn about “induced abortion” – so called to distinguish it from a miscarriage.

But the closure of abortion clinics in Texas following the passage of the strict abortion regulation law HB2 – more than 20 since 2013 — has made that training increasingly difficult.

Texas has 18 residency programs in ob-gyn, but only one allowed me to observe how abortion is taught. Because of the political pressures facing abortion providers, I agreed not to reveal the doctors’ full names or the clinic’s location. (The resident agreed to be identified by her middle name, Jane.)

Although residents can opt out of abortion training for religious or moral reasons, Jane felt a professional obligation to learn the procedure.

“This is part of ob-gyn, it’s not an optional part, per se,” Jane said. “Women can choose if they want an abortion or not, but you as their doctor need to be able to provide them with all the choices available.”

Jane spent that morning performing ultrasounds on pregnant women, working alongside a senior doctor who supervised. Together, the two women examined a printout from a fetal ultrasound, and the senior doctor offered some feedback.

“On this image here, you want it more of a plane, as if you were opening it like this, so that you have the hypothalamus in your picture,” the doctor advised Jane. “That’s going to give you a better measurement.”

Doctors do ultrasounds before abortions in order to date the pregnancy, which helps determine which technique will be used to terminate the pregnancy. In some states, like Texas, an ultrasound is also mandated by state law.

Jane spent about a month at this family planning clinic during the third year of her residency. Abortion is just one of the skills she learned. She counseled patients about abortion, contraception and sexually-transmitted diseases. She also learned techniques for pain management and dilation of the cervix.

Many of those skills will be useful in other practice areas, Jane said. For instance, ob-gyns use ultrasounds for many different reasons.